The Risk of Penetration or Aspiration during Videofluoroscopic Examination of Swallowing Varies Depending on Food Types

The Risk of Penetration or Aspiration during Videofluoroscopic Examination of Swallowing Varies Depending on Food Types

KENICHIRO OZAKI,^1,2 HITOSHI KAGAYA,¹ MICHIO YOKOYAMA,¹ EIICHI SAITOH,¹ SUMIKO OKADA,³ MARLÍS GONZÁLEZ-FERNÁNDEZ,⁴ JEFFREY B. PALMER^4,5 and HIROSHI UEMATSU²

¹Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
²Department of Gerodontology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
³Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
⁴Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Boltimore, Maryland, USA
⁵Department of Otolaryngology-Head and Neck Surgery and Center for Functional Anatomy and Evolution, Johns Hopkins University, Boltimore, Maryland, USA

Videofluoroscopic examination of swallowing (VF) is the gold standard in diagnosis and management of dysphagia. During VF, the patient ingests radiopaque foods and liquids, and oral, pharyngeal, and esophageal stages of swallowing physiology are observed and evaluated. Aspiration is defined as passage of materials through the vocal folds, and laryngeal penetration is defined as passage of materials into the larynx, but not through the vocal folds. In this study, we compared the risk of laryngeal penetration or aspiration during VF using various liquid volumes and food consistencies. Between January 2006 and September 2008, 229 patients with suspected dysphagia each were fed at least 2 out of 6 types of liquids or foods during VF in an upright posture without compensatory maneuvers. The 6 types were pudding-thick barium of 4 ml (PD), thin liquid barium of 4 ml (LQ4) and 10 ml (LQ10), one swallow of thin liquid barium from a cup (CUP), corned beef hash (8 g) with barium (CB), and a two-phase mixture of corned beef hash (4 g) with barium and thin liquid barium of 5 ml (MX). The paired comparisons revealed that laryngeal penetration risk increased in the following order: PD, CB, LQ4, LQ10, MX and CUP, while aspiration risk after PD increased in the following order: CB, LQ4, LQ10, CUP and MX. Thus, risk of laryngeal penetration or aspiration varies, depending on food types. In conclusion, risk of aspiration is highest with the two-phase food, and multi-textured foods should be used with caution in individuals with dysphagia.

keywords —— Aspiration; laryngeal penetration; videofluoroscopic examination of swallowing; deglutition; deglutition disorders

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Tohoku J. Exp. Med., 2010, 220, 41-46

Correspondence: Kenichiro Ozaki, D.D.S., Department of Gerodontology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

e-mail: oza-gerd@tmd.ac.jp